Introduction: Port wine stains (PWS) are vascular malformations present at birth, and, depending on their location, they can cause emotional changes in the patient. Studies on the treatment of PWS with intense pulsed light (IPL) and other types of lasers presented different responses. Objectives: The objective of this study was to review the literature on the treatment options of PWS with light sources, demonstrating the success of IPL associated with Nd:YAG laser. Method: A 14 years old female patient with PWS in the supralabial region was treated with the association of 1064- nm Nd:YAG laser and 560-nm IPL. She underwent eight treatment sessions with a mean interval of 30 days between each session. The study was conducted at the Célia Kalil Dermatology Clinic. Result: The port wine stains disappeared completely with a very low incidence of adverse events. Conclusion: The association of 560-nm IPL and 1064-nm Nd:YAG laser seemed an adequate treatment alternative for PWS.

Keywords: PORT WINE STAINS, LASERS, IPL, TREATMENT

Laser procedures are currently widely used in dermatology due to their low aggressiveness, excellent results, and fast recovery time with few complications.They are indicated in the treatment of photoaging, for removing or attenuating vascular alterations and pigmented lesions, and treating scars and excessive hairs.These lasers offer high levels of safety, however they can cause serious complications if used improperly.The objective of this study is to describe the side effects caused by different lasers and how to manage them, since there are few studies on this topic.This knowledge is crucial for improving patient care and preventing morbidity and sequelae. Side effects caused by non-fractional non-ablative lasers will be discussed in Part I of this paper. Fractional and non-fractional ablative lasers, as well as fractional non-ablative lasers, will be discussed in Part II.

Keywords: LASERS, POSTOPERATIVE COMPLICATIONS, HAIR REMOVAL, LASER THERAPY, HYPERPIGMENTATION

Introdução: Hyaluronic acid has been increasingly used in aesthetic procedures. Objective: To evaluate the degree of improvement and duration of results in patients who received treatment for wrinkles with hyaluronic acid.
Methods: Prospective, open, non-randomized, non-controlled study of 20 female patients who presented superficial wrinkles in the superior lips contour and a prominent nasolabial fold. The efficacy of hyaluronic acid was assessed using the Wrinkle Severity Rating Scale. The duration of results was assessed through biopsies. Safety was evaluated through clinical observation and reports of adverse events.
Results: A significant clinical improvement was observed after 15 days, which was sustained for 4 months. A minor worsening was observed after that period, although patients still presented favorable aesthetic results up to 12 months after the procedure. A majority of patients (n = 17) had a biopsy in the left retro-auricular region 180 days after the procedure. From this group, the substance was observed in 13 slides (76.4%).
Conclusion: Hyaluronic acid is an effective and safe product. This study has proven that the product remains in the dermis for up to 6 months.

Keywords: HYALURONIC ACID, RESIDENCE TIME, SKIN

Conventional ablative lasers remove the epidermis and part of the dermis completely, and achieve excellent results in the treatment of photoaging. Non-ablative lasers have become more popular, since they inflict less thermal damage on the dermis and do not remove the epidermis, thus reducing the recovery time and the risk of side effects. Fractioning has recently been introduced in non-ablative lasers, with the goal of developing a system with the efficiency of the ablative and the safety of the non-ablative lasers. Fractional ablative lasers form total dermal-epidermic ablation columns, whereas fractional non-ablative lasers generate microscopic zones of dermal-epidermic thermal lesions, yet they preserve the stratum corneum.

Keywords: LASERS, CARBON DIOXIDE, POSTOPERATIVE COMPLICATIONS, REJUVENATION, PHOTOAGING

Intense pulsed light is a device that emits high intensity, polychromatic, non-coherent and not collimated light. IPL versatility allows combining parameters to treat a variety of skin vascular and melanocytic lesions, epilation and non ablative photorejuvenation. This article describes classic and innovative indications for intense pulsed light use based on medical literature.

Keywords: INTENSE PULSED LIGHT THERAPY; SKIN DISEASES; COSMETIC TECHNIQUES

Both microneedling and ablative fractional laser can be used for the treatment of scars. The present article reports the case of a female patient who had the first half of a perioral scar treated with ablative fractional CO2 laser, and the second half treated with microneedling, using a 2mm roller. Outcomes were superior in the half treated with laser.

Keywords: Cicatrix; Collagen; Lasers

INTRODUCTION: The treatment of unsightly hypertrophic scars secondary to surgeries in the thoracic region area challenging, particularly if associated to striae distensae. Surely, more than one therapy should be used, which will demand a long treatment time.
OBJECTIVES: To evaluate the effect of the association of fractional ablative and non-ablative lasers, microneedling and drug delivery in the management of hypertrophic scarring and striae distensae.
METHODS: Patient showing hypertrophic scars and striae on the anterior thoracic region was submitted to four monthly sessions of fractional ablative and non-ablative lasers, associated to microneedling and drug delivery.
RESULTS: At the end of the treatment protocol, the patient had improved mobility of the treated areas, quality of the skin and striae distensae in the treated region.
CONCLUSIONS: The associated treatment showed good results in the concurrent management of atrophic and hypertrophic scars.

Keywords: Cicatrix; Lasers; Needles

INTRODUCTION: The chest is a photoexposed area that shows effects of photodamage. Microneedling is a safe option for the rejuvenation of this area, also leading to improvement in dyschromias.
OBJECTIVE: To evaluate histologic cutaneous response after three monthly sessions of microneedling for the treatment of dyschromias on the chest.
METHODS: Three monthly sessions of microneedling, with 1.5mm length needles were performed, as well as skin biopsies before and 90 days after commencement of the study. Histologic samples were evaluated with H&E and Fontana-Masson stains. Melanin content was measured based on dermal clusters.
RESULTS: Six patients between 38 and 67 years of age, phototypes II-III, Glogau scale II-IV were included. A positive correlation was observed between the time and dermal content of melanin (p=0.029): three sessions of microneedling reduced this content on D90 compared to the beginning (6.4 ± 1.7 MC on D0 versus 3.1 ± 0.4 on D90, p = 0.05). Three patients reported global skin improvement on D90.
CONCLUSIONS: The proposed mechanism of microneedling to promote lightening includes fibroblast proliferation and neocollagenesis in the upper dermis. This is the first study to evaluate the histology of the findings associated to lightening of the chest due to microneedling.

Keywords: Histology; Melanins; Needles; Thorax

INTRODUCTION: Idiopathic guttate hypomelanosis is an acquired leukoderma, whose available therapeutic options have inconsistent results.
OBJECTIVES: To evaluate the effect of isolated or combined ablative fractionated laser to drug delivery of piperine for treatment of idiopathic guttate hypomelanosis.
MATERIALS AND METHODS: In a prospective and comparative study, seven patients with idiopathic guttate hypomelanosis in the legs were elected, andfive lesions were selected on each leg of each. Both legs of each patient were submitted to two Er:YAG 2940nm laser sessions, followed by drug delivery of piperine 20% only in the right leg. Blind evaluators conducted the assessment through photographs and comparative measurements of the lesions.
RESULTS: The lesion size ranged from 0.2cm to 1.5 cm. Both treatments significantly reduced lesion size (p< 0.00008, right leg;p< 0.002, left leg). Thegeneralized estimating equation method showed that there was no statistical difference between the groups regarding the reduction of lesion size. The evaluation achieved better scores for the right leg (laser + piperine) (p=0.126).
CONCLUSION: Although statistically significant differences were not found between the side treated with laser and drug delivery versus the side treated only with laser, we believe that the technique may represent an option in the therapeutic arsenal.

Keywords: Administration, topical; Drug administration routes; Lasers

INTRODUCTION: Topical delivery of drugs is essential in Dermatology Due to the difficulty of permeation of the stratum corneum, drug delivery techniques have been highlighted. The use of non-specific formulations for this purpose makes raises the concern of possible adverse events and the microbiological safety of these formulations.
OBJECTIVE: To assess bacterial and fungal growth in anhydrous fluid serum through simple sterility test. Materials and METHODS: The simple sterility test was performed on an anhydrous serum containing lipophilic and hydrophilic active substances. This test was performed three months after the manufacture of the product.
RESULTS: The formulation studied was approved in the simple sterility test conducted three months after the manufacture of the product, even without the use of preservatives in the formulation.
DISCUSSION: The assessed formulation was approved in the sterility test possibly due to the fact that the serum vehicle has mineral and anhydrous origin, characteristics that do not favor the proliferation of microorganisms.
CONCLUSIONS: Although only the vehicle counting specific assets has been tested, the results of this study are promising and demonstrate the need for future studies broadly encompassing this subject.

Keywords: Drug Administration Routes; Brazilian Pharmacopeia; Skin Cream

The number of evidence supporting the existence of a “gut-skin axis” correlation has grown. There is also a suggestion that the intestinal microbiota modulation may play an essential role in dermatological diseases. Studies have shown that probiotics' oral use can have beneficial effects in treating skin diseases with inflammatory origins such as atopic dermatitis, acne, and others. However, there is no standardization as to what doses or species should be used for the treatments. We provide an overview of the use of probiotics as a treatment for dermatological diseases, focusing on mechanisms of action and clinical results reported in the literature.

Keywords: Probiotics; Skin; Skin diseases

Q-switched lasers are widely used for tattoo removal. A 48-year-old-woman with a black tattoo on the left thigh was submitted to ten sessions of Q-switched Nd:YAG 1064nm laser associated with fractional CO2 laser, performed every two months. Six months after treatment end, we observed almost complete tattoo removal, besides improvement in skin texture. Q-switched lasers promote tattoo removal by a photoacoustic phenomenon. The association with fractional ablative lasers is an option for intensely pigmented tattoos or for tattoos with several colors, which are hard to remove.

Keywords: Laser Therapy; Lasers; Tattooing

INTRODUCTION: Angiokeratoma of Fordyce are benign vascular lesions that present as small, asymptomatic, purple papule on the scrotum, shaft of the penis, or labia majora. Therapeutic options comprise several methods, including lasers.
CASE REPORT: Men presented with multiple violaceous papules on the scrotum, compatible with angiokeratoma of Fordyce. The patient was treated with a single session of long pulsed Nd:YAG 1064 nm laser.
DISCUSSION: Treating angiokeratomas with lasers has the benefit of allowing vessel coagulation without bleeding.
CONCLUSION: Even though these are benign lesions, patients seek treatment because of cosmetic concerns. Dermatologists should be aware of treatment options available.

Keywords: Ambulatory Surgical Procedures; Dermatology; Nails

In recent years, there has been an increasing trend toward the search for nature-friendly cosmetics without chemical or synthetic ingredients, thus boosting sales of products within this market niche. Currently, the term clean beauty refers to products that do not contain ingredients with unknown impacts on our bodies or that are potentially harmful to the environment. However, the definition of green beauty products, as well as vegan, natural, or organic products, is not regulated by ANVISA. Therefore, this study aimed to review these definitions to facilitate the medical understanding of the subject.

Keywords: Beauty; Cosmetics; Beauty products; Green chemistry Technology

INTRODUCTION: Non-ablative fractional lasers are well-known effective treatments for skin rejuvenation. However, the high incidence of post-inflammatory hyperpigmentation increases the risk of complications, especially in higher skin phototypes. Caviar phospholipid supplementation has been used successfully to reduce the inflammatory process, which may be beneficial to manage post-inflammatory hyperpigmentation after laser.
OBJECTIVE: To compare the incidence of post-inflammatory hyperpigmentation in high phototypes after caviar phospholipid supplementation.
METHODS: 20 patients underwent a non-ablative fractional laser session (Nd:YAP 1340nm, Zye Vydence, Brazil), and 10 of them used 200 mg of caviar phospholipid orally daily for 15 days before treatment and 40 days after. Patient images were evaluated before and after 40 days of laser application. Clinical assessment was based on the presence or absence of post-inflammatory hyperpigmentation. Statistical analysis was performed using the Z test.
RESULTS: We observed no cases of post-inflammatory hyperpigmentation in the experimental group; however, the control group presented 30%.
CONCLUSIONS: Caviar phospholipid may be an option for preventing post-inflammatory hyperpigmentation after non-ablative fractional lasers, aiming to avoid adverse events.

Keywords: Lasers; Skin; Rejuvenation; Fatty Acids; Omega-3.

A patient with dissecting folliculitis of the scalp who did not respond to antibiotic therapy received four monthly sessions of intradermal administration of 100 IU of botulinum toxin A. Four months after treatment, a complete recovery of the affected area of the patient's scalp was observed. A biopsy taken from the affected area showed the presence of Staphylococcus lugdunensis and Staphylococcus aureus resistant to erythromycin. Botulinum toxin A had no effect on the viability or biofilm production of the Staphylococcus strains, indicating that the healing effect of the toxin was associated with the host response alone.

Keywords: Botulinum Toxins Type A; Folliculitis; Alopecia; Staphylococcus aureus; Staphylococcus lugdunensis.

The 1064-nm Nd:YAG laser in Q-switched and micropulsed modes has been used in rejuvenation, pore reduction, skin texture improvement, and wrinkle reduction. The aim of this study is to evaluate the combination of 1064-nm Nd:YAG laser in micropulsed and Q-switched modes in the same session for global facial treatment. Thirty female patients underwent six treatment sessions every two weeks. Three blinded dermatologists evaluated the results through clinical photographs and Visia^® or Focco^® images obtained before and 30 days after the last treatment session. The parameters of interest were solar melanosis, telangiectasias, wrinkles, dilated pores, melasma and skin texture. Three patients had face biopsies before and 30 days after the end of treatment. Most patients showed improvement in all evaluated parameters, except for two patients who had worsening of melasma. An increase in collagen was observed in two of the three histological examinations performed after treatment. The combination of laser modes studied herein offers a safe treatment that can improve wrinkles, skin texture, and laxity with minimal downtime.

Keywords: Lasers; Skin Aging; Rejuvenation